MEDICARE: DR. GARRETT H. PEARD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD23701	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124025580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARRETT H. PEARD MD

Provider Business Mailing Address
First Line	:	PO BOX 3158
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3158
Country	:	US
Telephone Number	:	541-734-3430
Fax Number	:	541-734-3638

Provider Business Practice Location Address
First Line	:	3225 HILLCREST PARK DRIVE
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504
Country	:	US
Telephone Number	:	541-734-3430
Fax Number	:	541-734-3638

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	10/06/2020

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